“Helpful in Thinking Through the Question”: Redesigning the Patient Health Questionnaire-8 for Depression Assessment to Enhance Patient Engagement and Understanding

Background: Major depressive disorder (MDD) is a prevalent and impairing mental health condition characterized by persistent low mood and diminished energy. Self-report instruments, such as the Patient Health Questionnaire-8 (PHQ-8), are frequently used in clinical and research settings for depression assessment. Objective: We developed, redesigned, and tested 2 alternative versions of the PHQ-8 that incorporate visual elements and reframed statements aimed at improving acceptability and comprehension. Methods: In a mixed methods study, 20 participants with high subclinical to moderately severe depressive symptoms provided feedback after completing 3 versions: the standard PHQ-8 form, our version augmented with visual aids, and our version that combined visual aids with rephrased item statements for greater clarity and engagement. Results: Eighty percent (16/20) of participants preferred one of the augmented PHQ-8 versions over the standard questionnaire (P=.006). Conclusions: Participants reported that the augmented versions improved their understanding of survey items, reduced response burden, and increased engagement, suggesting that visual and linguistic design modifications may enhance the patient experience in depression screening.